Provider Demographics
NPI:1417328071
Name:WEISBERG, RICHARD N (PHD, LCSW, BCD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:N
Last Name:WEISBERG
Suffix:
Gender:M
Credentials:PHD, LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 VANTIS
Mailing Address - Street 2:SUITE 540
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2676
Mailing Address - Country:US
Mailing Address - Phone:949-495-9800
Mailing Address - Fax:
Practice Address - Street 1:120 VANTIS
Practice Address - Street 2:SUITE 540
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-2676
Practice Address - Country:US
Practice Address - Phone:949-495-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW92921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical